Wellness · Dec 20, 2020

The Power of Recovery - Injury prevention & recovery optimisation

“Every under-recovered athlete is uniquely under-recovered. Try and learn how to read your body - what are the signs that you’re under-recovered and be aware that they can be physical and mental.”

Recovery, when understood and managed well at an individual level, can improve our training performance and reduce the risk of injury. I sat down with Alexandra Orfanides, an expert in all things sports injuries, to discuss injury prevention and recovery optimisation for women in functional training.

Alexandra is a Soft Tissue Injury specialist who focuses on scar tissue (known as “fibrosis") often caused through repetitive strain injuries. Working with everyday and elite athletes, including Annie Thorisdottir (2x CrossFit Games Champion), she has a keen interest in female physiology and using biomarkers to improve athletic performance as well as general health in her patients. Her background was as an elite-level swimmer, but following chronic shoulder injuries, she was forced to stop and later took up CrossFit.
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What affects our risk of injury?

Having had a previous injury - this puts you at greater risk of subsequent injuries.
Menstrual cycle* - around ovulation your ligamentous laxity increases (they become more stretchy), leading to loose joints that bend more than usual. This is partly why we see a lot of ACL tears in women's football.
Hyper-mobility - if you are hyper-mobile you are at greater risk of injury due to uncontrolled movement in your joints. It is helpful to put on muscle mass to stop joints from moving beyond extension because the connective tissue of the joint (ligaments and joint capsule) cannot be relied upon to limit movement appropriately.

Shoulders, hips, and knees are the most common injuries in functional training for women.

*There is not enough data on how hormonal birth control affects injury risk.

How to manage a previous or current injury

Soft tissue injuries result in tissue scarring. The scar that forms can either heal well, leaving you with a hard scar (which will not get re-injured) or a soft scar (this is a failed attempt by the tissue to scar, which is at significant risk of injury over the original injury site). However, even with a perfect hard scar, it is important to remember that the tissue around the circumference of the scar is at a greater risk of re-injury (this is due to a difference in tissue extensibility). Although a previously injured area will always be vulnerable to re-injury to some extent, there are things you can do to significantly reduce the risk:

Body literacy - learn to read your body and be aware of the tissue vulnerability around the sites of previous injuries. Question what people tell you (clinicians included) and remember that it’s your body, and you have a right to understand what you are doing and why.
Mobilise affected muscles before training - ideally, you will have a tailored mobilisation/warm-up programme from a coach or physio who is familiar with your injury history. Part of your warm-up should include heating up your body (you should get slightly sweaty and feel warm). This takes advantage of the thixotropy of connective tissue, which is the ability of connective tissue to change state from more solid to more liquid. Think of cold butter melting.
Use movement screens in your warm-up - think of this as ‘systems testing’. Check the affected areas of your body, attempt to do targeted mobilisation exercises, and ask yourself “does it feel the same, better or worse”. If your injury has been properly diagnosed and you have been given the correct mobilisation exercises, you should be able to change the function of the affected area in real-time. Don’t begin training before you are happy with your movement.
Alter the programme - if you’re in a class-based setting speak to your coach so you can alter the programme if required. One pro-tip: consider asking to do barbell movements from the hang if you feel worried about your lower back.

How to reduce injury risk

Bundle up - if your gym is cold make sure you layer up before and after your session. Being physically warm helps your muscles change state before and after training. You want your connective tissue to have changed state before training.
Let your muscles repair - post-training you don’t want to blunt or dampen the inflammatory process in your muscles. The muscle damage from training triggers a ‘remodelling’ process which helps the muscles repair and overtime get stronger. You need to keep moving and take your tissues through the full range of motion to inform your fibres how to remodel to maintain and improve mobility.
Build in active recovery - where possible do 15-30 minutes of active recovery after training. A short walk or row/bike. This increases blood flow and helps blood vessels pump nutrients into your tissues whilst taking away waste products. It should feel very easy.
Take a complete rest day - when your body and mind tells you it's necessary. A good cadence is usually once a week or once every 10 days, but it’s very individual. Make sure this is a complete rest day, physically and mentally.

Final Tips

Optimise bone density - women’s bone density peaks in their late 20s and early 30s, it's then stable until it declines due to menopause. The higher you can get your bone density at this age the better - strength training has a positive impact on bone density.
Identify hyper-mobility - this can present itself in different ways. If you are concerned you should see a medical professional to diagnose. Things to look out for include bowl and gut issues, low blood pressure, getting lightheaded when you go from sitting to standing, and very soft skin.
Prioritise becoming body literate - learn how to read your body and what it's telling you. Identify what your physical and mental signs are that you’re under-recovered and lean into them.